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A new approach to preexisting vertical midline abdominal scars with crossover DIEP flap breast reconstruction
Author(s) -
Hsieh Frank,
Somia Naveen,
Lam Thomas C.
Publication year - 2009
Publication title -
microsurgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.031
H-Index - 63
eISSN - 1098-2752
pISSN - 0738-1085
DOI - 10.1002/micr.20705
Subject(s) - medicine , diep flap , breast reconstruction , anastomosis , scars , abdominal wall , surgery , abdomen , umbilicus (mollusc) , anatomy , breast cancer , cancer
Breast reconstruction using a free transverse rectus abdominis myocutaneous flap or a deep inferior epigastric perforator (DIEP) flap is a challenge in patients with a vertical midline abdominal scar due to the poor perfusion of the lower abdominal skin ellipse across the midline. In such patients, only one half of the abdominal skin ellipse can be used with certainty, and this limits the amount of tissue available for reconstructing the breast. Two cases of breast reconstruction in patients with a lower midline abdominal scar are presented using the DIEP flap, in which the poor perfusion across the midline scar was overcome by a technique of crossover anastomoses between the two deep inferior epigastric pedicles. Reliable perfusion of the entire lower abdominal skin ellipse was achieved. This crossover anastomoses technique overcomes the poor perfusion imposed by the vertical midline abdominal scar and enables DIEP flap breast reconstruction to be offered to women with midline abdominal scars. © 2009 Wiley‐Liss, Inc. Microsurgery, 2010.